July 15, 2022 - Weight Loss Surgery: Day of Bariatric Surgery

On this Bariatric Friday, Kemal Erkan, Chairman of American Surgery Center, is speaking with Dr. Isaias Irgau, President of Christiana Institute of Advanced Surgery (CHRIAS) and specialist in bariatric surgery, to discuss the steps taken on the patient’s day of bariatric surgery. Dr. Irgau and his team are leaders in the State of Delaware for this type of surgery and their facilities are recognized as centers of excellence.

The two reintroduce Samantha and Katrina, the hypothetical patients used to demonstrate the journey of undergoing bariatric surgery. Katrina is 37 years old with a body mass index (BMI) of 47 and no history of diabetes. She is undergoing a gastric sleeve. Samantha is 62 years old with a BMI of 42 and is receiving a gastric bypass. She has diabetes and heartburn.

From the first appointment to the date of the surgery, the process can take three to eight months. During this time, the patient will be evaluated by several medical professionals to ensure it is safe for them to undergo surgery. Erkan explains how patients become filled with nerves and excitement as the surgery date approaches. The surgical clearance appointment is the final appointment prior to the surgery. This appointment is necessary to confirm that all other requirements, including blood work, clearances, and numerous other medical tests, have been fulfilled before undergoing the procedure. This is to verify that the patient has completed and addressed all medical concerns. Dr. Irgau states he encourages patients to come to this appointment prepared to relay any fears and ask any last minute questions they may have related to the procedure. He also allows patients to bring a family member or friend to this appointment to aid in support of the patient prior to and following the procedure.

Dr. Irgau mentions patients must follow the Robard diet for the two weeks leading up to bariatric surgery. Erkan says, “We ask patients to place their order… when you go to our portal… choose what you like and it gives you the portions and how much you need to order… it is a food replacement”. This meal plan is not about losing weight; the main goal of this diet is to shrink the size of the liver. Dr. Igrau states, “the liver is a solid organ in our abdomen and when we are overweight, the liver tends to be large and also dense… to do the surgery on the stomach we have to push away the liver”. The liver covers about two-thirds of the stomach and must be soft to move it during the procedure to avoid complications. When the patients take on the Robard diet, they safely lose the fat that surrounds the liver. Dr. Irgau and Erkan mention how they have followed this diet before, so they understand what they are asking their patients to do to prepare for the surgery.

The American Surgery Center (ASC) contacts the patient a few days prior to surgery to confirm their surgical date and time, and to advise the patient to take two extra strength Tylenol prior to arrival at the surgery center. This is key for their recovery after the operation. The Tylenol primes the person to have less discomfort and nausea after the procedure. “If patients are able to recover from the surgery quicker, that minimizes complications.” Dr. Irgau continues to explain, “If a patient has had surgery and they are able to get up and walk within a couple of hours after their surgery, it means that the chances of them having blood clots and the chances of having pneumonia decrease considerably.” In addition to the recommendation for Tylenol, anti-nausea medication is administered from the surgery center. These medications will have a positive impact on the patient’s immediate wellbeing and ability to ingest fluids following surgery.

Dr. Irgau states, “Blood clots occurring after surgery is a known complication… being overweight and heavy actually increases the risk of having blood clots, so we have to pay

particular attention to this issue in our patients. He continues, “We will put special boots on the legs of the patients so that when they are asleep during surgery the circulation in their legs will be encouraged, and we give them a blood thinning medication before surgery as well”. All this preparation is geared to the patient’s health following the operation and minimizing the possible complications. Ninety-six percent of patients who undergo surgery at ASC return home six to eight hours following the surgery. This is because ASC takes extra precautions to ensure the patient feels well enough to return home the day of the procedure. Two weeks post surgery, the patient is scheduled for a followup visit in the office.

In the instance of Katrina and Samantha, following the surgery the two do not have any differences in their postoperative process. However, a patient recovering from gastric bypass surgery may need additional recovery time than a gastric sleeve, but, in both procedures, the patients are able to recover in the same way. Dr. Irgau explains, “Every individual will recover differently, in terms of their medical problems; of course, we will be paying attention… it is not necessarily the surgery that will bring about some differences.” Each patient has their own nurse who takes care of them as they recuperate. They have a one-on-one relationship with the nurse to ensure that all needs are met, and all concerns are addressed. “This is what they do the best,” Erkan states in reference to the nurses at American Surgery Center. ASC strives to provide the best environment for their patients and aims to have a seamless recovery for each patient.